After every member of the 13-person yoga class slowly moves into Warrior II, their arms parallel to the ground, their chest lifted and their torsos long and tall, they focus on their breath and repeat the words of their instructor, Lucy Wagner.

“I live my life with an open heart,” she says. “I live my life with an open heart,” the class says together.

“I'm no longer a prisoner in my body,” she says. “I'm no longer a prisoner in my body,” they repeat.

The class, a mix of ages, abilities, shapes and nationalities, has one thing in common: all of the members are American war veterans grappling with post traumatic stress disorder (PTSD).

Yoga and movement helps. In fact, before one Vietnam veteran began taking the specialized class for combat veterans, he used a cane and complained that his foot was cold. Since coming to the free weekly classes offered by Wagner, owner of the Central Mass Yoga Institute in West Boylston, MA, he feels warmth in his foot and doesn't use the cane at home or when he comes into the yoga studio.

“They're not the typical people you see in a yoga class, but they are receptive to it,” Wagner says. “I didn't know what to expect when I first started. Some of them have been holding these wounds of war for 30 years.”

Wagner isn't alone in her efforts to help injured veterans. A number of fitness- and sports-related programs are helping “wounded warriors” transition back to everyday life. Typically funded through military hospitals, nonprofit organizations and clubs' charitable efforts, these programs use physical activity to improve the outlook, mood and overall life of veterans after a major mental or physical injury.

These types of programs are filling a growing need. Although Wagner's class includes veterans from multiple wars, the conflict in Iraq has greatly increased the number of wounded veterans. According to the Department of Defense, almost 25,000 servicemen and servicewomen were wounded between March 2003 and March 2007 in Operation Iraqi Freedom. Recent media reports have criticized the Department of Veterans Affairs for the handling of veterans' post-action care.

“We consistently hear that when an injured veteran gets to the hospital, they're a rock star, and then once they get home, no one is calling anymore,” says John Register, associate director of military programs for the U.S. Paralympics, a division of the U.S. Olympic Committee. “Then the healing begins and depression starts setting in. We want sports and activity to be one of the tools for helping at that time.”

Register understands how important sports can be after an injury. A Desert Shield and Desert Storm veteran, Register won nine gold medals in track and field as part of the Army's World Class Athlete program. After qualifying for the 1992 Olympic trials in the 400-meter hurdles, his Olympic dreams were cut short in 1994 when he hyperextended his left knee after a faulty landing, resulting in the severing of the popliteal artery. An attempt to reconstruct the artery using a vein from his right leg failed, and within days gangrene turned the muscle black. Instead of leaving the useless left knee and ankle, which would confine him to a wheelchair, he chose amputation. Through the use of a prosthesis, Register learned to swim, ski and run again, winning a silver medal in the long jump at the 2000 Paralympic Games.

“Other individuals' [reaction to] people with a disability is that they shy away; it isn't polite to stare, and they don't make eye contact,” he says. “The way you get past that is through the acceptance of peers and friendship.”

The U.S. Paralympic military program provides that acceptance for athletes and non-athletes alike through sports camps, Register says. Earlier this month, more than 35 injured veterans gathered to learn how to compete and train for a triathlon.

“There's a certain level of fitness that people have to be at to be in the military,” he says. “Once they can't do it, we find that they want to do it. They're missing that part of their life, and we want to give it back to them.”

Operation Fitness

In the last few years, a select number of high-tech centers have been built to treat wounded service members. Brooke Army Medical Center in Fort Sam Houston, TX, is the site of the Department of Defense's second Amputee Care Center. Since its opening in January 2005, the center has treated more than 144 military members injured in the global war on terrorism. The Intrepid Fallen Heroes Fund, an independent nonprofit organization, funded the center, along with The Center for the Intrepid, a $50 million, 65,000-square-foot rehabilitation center, also located in Fort Sam Houston, TX.

The Center for the Intrepid opened in late January and features a cantilevered running track, a treadwall and 21-foot climbing tower with auto belay, and custom-designed elevating parallel bars. A gait laboratory analyzes human motion, and a computer-assisted rehabilitation environment immerses patients in a 21-foot simulator dome where patients use atrophied muscles and relearn skills necessary to do everything from walking on different terrains to driving a car. Prosthetists and technicians can fabricate artificial limbs onsite, including unique specialty limbs for sports and other activities. The facility also contains a six-lane pool and an indoor wave pool used to improve balance, strength and confidence.

The Comprehensive Combat Casualty Care Center, commonly called C5, opened last September at the Naval Medical Center San Diego (NMCSD) to provide research, education and training using leading edge technology for the care and management of the severely injured. The center also hosts the Balboa Warrior Athlete program, which introduces Paralympic and adaptive sports and fitness into the rehabilitation process.

“The first time we get them out [for activity], they're hesitant or refuse to try because they think it's impossible,” says Helen Metzger, department head for health promotions at NMCSD. “It's like a psychological barrier, but once they do it and adapt, it gives them confidence by just interacting with people and pushing themselves out there.”

In about a month, NMCSD will also launch a healthy living class to address weight gain for those who are severely injured, says Stephen K. Robinson, NMCSD assistant public affairs officer.

“Amputees are oftentimes used to living a very active lifestyle, and when something happens, especially to our legs, we lose that ability to be as active as we were before,” Robinson says. “We've lost weight because we've lost a limb but gained weight around our middle.”

The program will include cooking demonstrations, information on balancing energy intake and outtake, and hands-on experience cooking with a microwave, as most service members in barracks don't have access to stoves.

Once amputees begin exercising, they can actually burn more calories than they did before the injury.

“When they're in their prosthetics they're actually burning more energy because it takes more muscles to move,” says Jacqueline Coley, chief of C5's physical therapy division. “So the energy cost of what they're doing can help maintain their weight. We get a lot of these guys to do aerobic exercises.”

Administrators of military fitness centers are also looking to do more for their injured service members. Army Morale, Welfare and Recreation (MWR) is researching what programs are available for wounded soldiers and plans to market those programs to its soldiers or partner with the programs, says Karen White, chief of Army Sports, Fitness and Aquatics.

“It will be a two-part educational process of informing the MWR personnel on our installations and in turn, educating the soldiers as to what's out there,” she says. “We are looking at opening up programming opportunities for our installations as well.”

Fitness Recruitment

Although military facilities are focusing on rehabilitation, few health clubs offer programs specifically for wounded veterans.

In October 2004, Bally Total Fitness began offering complimentary memberships to disabled veterans nationwide after they partnered with Disabled Sports USA, a national nonprofit that offers sports rehabilitation programs to anyone with a permanent disability. Bally doesn't promote the free memberships to the general public, and the program has no planned end date, says Matt Messinger, spokesperson for Bally. Most veterans learn of the program through Disabled Sports USA or from their physical therapist at their military hospital.

About 10 percent of the 700 wounded veterans that Disabled Sports USA has worked with take advantage of the free membership, says Kirk Bauer, executive director of Disabled Sports USA. During the rehabilitation process, most veterans learn how to work out on the various pieces of equipment in a traditional health club.

“It's not a perfect system though, and we encourage Bally and other facilities that when they do a repurchase of equipment to make it adaptable to people in wheelchairs,” says Bauer, who lost a leg while serving in a combat unit in Vietnam. “The equipment is out there. Sometimes they take advantage of it. Sometimes they don't.”

Because many wounded veterans are amputees, machines that allow for independent movement are a good choice, as are stationary cycles with toe straps that help keep on an artificial leg. Aerodynamic leg-and-hand machines are also good choices, Bauer says.

However, few educational materials and workshops about how to train wounded veterans exist. Some certification bodies offer tracks on adaptive sports, but its reach to the general fitness instructor is minimal, Bauer says. There is no Bally-wide mandated certification or training to work with disabled veterans, although each new member, disabled or not, receives one complimentary personal training session, Messinger says.

Cedric Bryant, American Council on Exercise's chief science officer, recommends an advanced personal training degree or certification, such as a clinical exercise specialist certification, for trainers who want to work with disabled veterans. He also advises trainers to interview the person and pay close attention to their needs, goals and any emotional issues that may be connected to the disability. Trainers should also work with other medical professionals to ensure they stay within their scope of practice, Bryant says.

Vladimir Bellevue, expert personal trainer at Athletic Club Northeast in Atlanta, did just that when a 63-year-old Vietnam War veteran approached him, hoping to get back to running. The client had limited range of motion in his left leg due to shrapnel. After an interview and consultation with the club's physical therapist, the veteran trained with Bellevue for nine months, slowly increasing his range of motion so he could run again, albeit short distances.

“You have to be motivational, and that doesn't mean yelling at them but staying in their face and being there for them,” he says. “Putting yourself in their shoes is very, very important.”

Wagner has worked closely with medical professionals for the combat veteran yoga class she leads. In fact, the program began when the Worcester (MA) Veteran Center contacted her about leading a class at the center for veterans with PTSD. The class was so successful that she brought it to her facility. Attendance has increased from six participants to more than 50 with “more coming every time,” she says. The class is backed through private funding.

Other fitness facilities should consider offering specialized programming for war veterans, Bryant says.

“It's only right, given what they do for us, that we may want to consider a special area or special class devoted to our returning vets,” he says.

Making Your Fitness Center Welcoming to Wounded Warriors

Assess how environmental barriers can be removed and accessible features can be incorporated into all areas of your facility, including doors and entryways, restrooms and locker rooms, signage and equipment.

Go beyond the minimum requirements of the law to incorporate principles of universal design to make your facility accessible to more people.

Provide adaptive and assistive equipment that enables users of varying degrees of ability to use new and already existing equipment both safely and effectively.

Interact with people with disabilities as you would any other member, taking into account individual needs and utilizing the many exercise options that may be available.